'Toxic and unsupportive' work environment widespread at CancerCare Manitoba, report says
'I feel that I have to "watch my back" at every turn,' cancer agency doctor reported
A majority of the physicians who responded to a Doctors Manitoba request for feedback on CancerCare Manitoba say they're gravely concerned about the possibility their work environment may hurt their ability to provide proper care to patients, says a report obtained by CBC.
Doctors Manitoba, the professional association for physicians in the province, invited 117 physicians who work or recently worked with CancerCare to share their views in response to a Sept. 20 letter that described a "lack of trust and fear" at the Winnipeg cancer agency. Of the 117 invited, 57 doctors responded.
Recruitment and retention challenges, excessive and increasing workloads, a lack of communication from leadership and a culture of favouritism have contributed to what some physicians described as "a toxic and unsupportive work environment," the report says.
"Overall, the Doctors Manitoba review found serious concerns from a majority of physicians, concerns that require urgent attention to disrupt a workplace culture described by many physicians as toxic," the report says.
Some physicians believe leadership decisions are biased toward certain doctors when it comes to recruitment, promotions, research support and physician engagement.
"It feels like there's a small group of people who are in favour with the senior leadership, and the rest of us suffer," one respondent said.
Afraid to speak out
Some physicians reported a lack of transparency around decision-making, including distress around a perceived "ivory tower" approach to planning and change, the report says.
"Often, so-called process improvements are rolled out with little to no engagement of actual clinical staff," one respondent told Doctors Manitoba.
The report also found a significant number of physicians were reluctant to share their concerns, with many asking for "assurances of confidentiality and protection" for fear of retribution from senior leadership. There was a strong theme among early career physicians of being concerned about the ramifications of speaking out, the report says.
"I feel that I have to 'watch my back' at every turn because I do not trust that individuals around me won't turn on me for anything I do," a respondent said.
In the annual physicians survey from Doctors Manitoba earlier this year, just 13 per cent of respondents felt the health system is responsive to physician concerns, and just 38 per cent felt they are able to raise concerns without fear of consequences.
Other concerns from the CancerCare physicians who responded revolve around the challenges associated with high staff turnover and ever-growing workloads.
Sixteen physicians have left CancerCare in the past five years, with 19 more having been recruited in that span — "a concerning level of turnover that is at least three times higher than the average physician turnover rate for Manitoba," the report says.
Recruitment challenges have also been linked to a pending lawsuit that alleges a recruitment contract was broken by senior administration within the cancer agency, the report says.
Just over one-quarter — 28 per cent — of the physicians said they felt confident a physician could be recruited to fill their role if they left, the report says.
The agency reported 10 physician vacancies as of October. Six of those vacancies have been filled, but the start dates for incoming physicians stretch into August 2025.
Some physicians said they couldn't "in good conscience" encourage colleagues from other jurisdictions to take a position at CancerCare Manitoba, the report says.
More doctors are needed to provide the kind of response and care for which CancerCare has historically been lauded, the report says.
'Coached or coerced'
Although most of the feedback painted a negative picture of the cancer agency, nine responses included a similar positive comment: CancerCare leadership is "doing the best that they could" considering the challenges associated with health-care recruitment.
However, Doctors Manitoba heard from several physicians that others were "strongly encouraged by senior administration to send in positive feedback as part of the review, with suggestions this was coached or coerced," the report says.
"A careful review of the substance of these multiple accounts suggests these concerns are credible."
Other allegations, such as inappropriate conduct by senior CancerCare administration that could include breaching the ethics code, have been shared with the agency's board, as well as the provincial ombudsman.
In a Wednesday statement emailed to CBC, the ombudsman's office said because it is "required to conduct assessments and investigations in private," it only comments on reports released publicly, and will not comment on this report.
The report makes recommendations focused on four themes: rebuilding trust and psychological safety of physicians, improving physician engagement, focusing on physician wellness, and supporting excellence in leadership.
It also points to available tools and training that can help accomplish those goals, from organizations such as the Institute for Healthcare Improvement, the Canadian Medical Association and the American Medical Association.
Acting on these recommendations will help the agency fulfil the commitment all health-care systems have in Manitoba under the Shared Health Quality and Learning Framework to "simplify and strengthen governance and accountability for quality across the system," the report says.
The report will be shared with physicians connected with CancerCare, as well as relevant health-care system leaders, it says.
CancerCare board chair Jeoff Chipman said Wednesday there are "various aspects of the report" that the board disagrees with, but that concerns will be "taken very seriously."
"I can assure you that the board and leadership at CancerCare are committed to creating a culture of wellness for all physicians and staff at [the agency]," Chipman said in a statement to CBC.
Outgoing CancerCare chief executive officer Dr. Sri Navaratnam is "saddened and troubled" by the unhappiness of some of the agency's physicians, Chipman also said.
Uzoma Asagwara, Manitoba's health minister, has been in contact with CancerCare's board of directors to ensure the concerns of physicians are being respected, they said in a statement emailed to CBC on Wednesday.
"I have been assured that CancerCare will address these concerns," Asagwara said.
Despite issues raised in the report, Asagwara said the future of the cancer agency "looks bright," and the delivery of a new 10-year plan will "guide the next decade of excellent cancer services in Manitoba."
Doctors Manitoba declined to comment on the report.
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